Individual
DR. MICHAEL PETTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7500 MERCY RD, OMAHA, NE 68124
(402) 343-8760
(402) 343-8765
Mailing address
7710 MERCY RD SUITE 424, OMAHA, NE 68124
(402) 343-8760
(402) 343-8765
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
18239
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47079756000
—
NE
Enumeration date
08/19/2006
Last updated
07/08/2007
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